Socioeconomic status affects achievement of blood pressure target in hypertension: contemporary results from the Swedish primary care cardiovascular database

Abstract

Objective: To assess the relation between socioeconomic status and achievement of target blood pressure in hypertension. Design: Retrospective longitudinal cohort study between 2001 and 2014. Setting: Primary health care in Skaraborg, Sweden. Subjects: 48,254 patients all older than 30 years, and 53.3% women, with diagnosed hypertension. Main outcome measures: Proportion of patients who achieved a blood pressure target <140/90 mmHg in relation to the country of birth, personal disposable income, and educational level. Results: Patients had a lower likelihood of achieving the blood pressure target if they were born in a Nordic country outside Sweden [risk ratio 0.92; 95% confidence interval (CI) 0.88–0.97], or born in Europe outside the Nordic countries (risk ratio 0.87; 95% CI 0.82–0.92), compared to those born in Sweden. Patients in the lowest income quantile had a lower likelihood to achieve blood pressure target, as compared to the highest quantile (risk ratio 0.93; 95% CI 0.90–0.96). Educational level was not associated with outcome. Women but not men in the lowest income quantile were less likely to achieve the blood pressure target. There was no sex difference in achieved blood pressure target with respect to the country of birth or educational level. Conclusion: In this real-world population of primary care patients with hypertension in Sweden, being born in a foreign European country and having a lower income were factors associated with poorer blood pressure control.KEY POINTS The association between socioeconomic status and achieving blood pressure targets in hypertension has been ambiguous. •In this study of 48,254 patients with hypertension, lower income was associated with a reduced likelihood to achieve blood pressure control. •Being born in a foreign European country is associated with a lower likelihood to achieve blood pressure control. •We found no association between educational level and achieved blood pressure control.